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Biomedical subjects

J Carlsson

Publications and source records attributed to J Carlsson.

At least 55 records · Page 3Linked to original sources
PubMed2001

Walking training of patients with hemiparesis at an early stage after stroke: a comparison of walking training on a treadmill with body weight support and walking training on the ground.

OBJECTIVE: To compare the effect of walking training on a treadmill with body weight support (BWS) and walking training on the ground at an early stage of rehabilitation in patients with hemiparesis after stroke. DESIGN: Randomized controlled experimental study. SETTING: Multicentre design; three departments of rehabilitation medicine. SUBJECTS: Seventy-three consecutive first stroke patients admitted to a rehabilitation clinic were randomized into a treatment group and a control group. INTERVENTIONS: The treatment group received walking training on a treadmill with BWS for 30 minutes, 5 days a week. The control group received walking training according to the Motor Relearning Programme (MRP) on the ground for 30 minutes 5 days a week, not including treadmill training. During the time in the rehabilitation department (about two months), all patients in the study also received professional stroke rehabilitation besides the walking training in the two groups. MAIN OUTCOME MEASURES: Functional Independence Measure (FIM), walking velocity for 10 m, Functional Ambulation Classification (FAC), Fugl-Meyer Stroke Assessment and Berg's Balance Scale. The assessments were performed at admission, at discharge and at 10-month follow-up. RESULTS: There were no statistically significant differences between the groups at discharge or at the 10-month follow-up with regard to FIM, walking velocity, FAC, Fugl-Meyer Stroke Assessment, and Berg's Balance Scale. Patients in both groups improved in these variables from admission to the 10-month follow-up. CONCLUSIONS: Treadmill training with BWS at an early stage of rehabilitation after stroke is a comparable choice to walking training on the ground.

Adult↗
PubMed2001

Influence of selenium on mercuric chloride cellular uptake and toxicity indicating protection: studies on cultured K-562 cells.

Selenium and mercuric chloride (MC) interactions regarding cellular uptake and selenium protection on MC toxicity have been studied. Human K-562 cells were pretreated or simultaneously treated with either selenite (5 or 50 microM) or selenomethionine (10 or 50 microM) together with MC (35 or 50 microM). Both treatments with selenite showed an increase of mercury uptake with increased selenium dose. In the pretreated or simultaneously treated selenite and 35 microM MC combinations, no inhibition of growth was seen, whereas all 50-microM MC combinations were toxic to the cells. A selenite-dependent protection was obtained for both exposure protocols when considering the cellular uptake of mercury. The cells died when the accumulation on d 4 reached more than about 0.8 x 10(-15) mol/cell of mercury, whereas they survived up to twofold more mercury uptake when exposed to selenite. Selenomethionine gave, with a few exceptions, similar effects as selenite on MC uptake and toxicity.

Dose-Response Relationship, Drug↗
PubMed2000

Membrane assisted isoform immunoassay. A rapid method for the separation and determination of protein isoforms in an integrated immunoassay.

Proteins often exist as isoforms with structural microheterogenity due to, for example, small variations in their carbohydrate structure. This can give rise to differences in biological activity. Measurements of low concentrations of such isoforms are usually performed by complicated methods, which demand discrete steps of separation (chromatographic or electrophoretic) and immunodetection. In this paper a new, highly specific and rapid (<15 min) analytical technique is described which permits the quantitative determination of several types of protein isoform. The method, which is called membrane assisted isoform immunoassay (MAIIA), is based on separation (by ion-exchange or affinity chromatography) and immunoassay detection of the protein isoforms in the same lateral flow, assisted by capillary forces in a membrane device. The technique is exemplified with a method for measuring carbohydrate-deficient isoforms of the glycoprotein transferrin, where the measured isoforms constitute a minimal part (<3%) of the total amount of transferrin. The time for the measurement was about 10 min and the correlation coefficient with an established, commercial two-step procedure, which takes 4-5 h to perform, was 0. 99. The detection limit was about 1 fmol of transferrin. The anion-exchange membrane used in the test device had the ability to separate transferrin isoforms with down to 0.1 unit difference in pI. The results indicate that the technique should be useful for rapid point-of-care testing of clinically interesting charged protein isoforms.

Anions↗
PubMed2000

[Recurrent syncope of unknown origin. Diagnosis with implantable "loop" recorders].

BACKGROUND: In about a third of cases of recurrent syncope a diagnosis cannot be established despite extensive cardiovascular and neurologic testing. In patients without underlying heart disease the sensitivity of conventional diagnostic testing is low. CASE REPORT: A 33-year-old male patient underwent implantation of a loop recorder (Reveal) after negative neurological and cardiovascular testing. One month after implantation sinus node arrest could be documented during a presyncope. The patient underwent pacemaker implantation and remains asymptomatic since then. CONCLUSION: In patients with syncope and a negative conventional diagnostic workup the implantable loop recorder is a helpful and cost-effective diagnostic tool.

Adult↗
PubMed2000

[Recurrent syncope in a 34-year-old woman triathlete].

HISTORY: Some weeks previously a 34-year old athlete, specializing in the triathlon, had 6 syncopes in one day. They had caused abrasions and contusions resulting from the falls. At another hospital paroxysmal atrial fibrillation had been diagnosed and treatment with disopyramide (2 x 200 mg) initiated, but she had about 15 further syncopes within 2 weeks. She was admitted for establishing their cause. INVESTIGATIONS: Initial ECGs and neurological examination failed to provide a diagnosis and she was discharged with an "event recorder". DIAGNOSIS, TREATMENT AND COURSE: Three weeks after discharge she had another syncope. The event recorder was activated by the patient's partner and revealed polymorphous ventricular tachycardia. She underwent extensive invasive cardiological tests, including a right ventricular biopsy, but no abnormality was demonstrated. However, a provocation test with ajmaline produced ST segment elevations in V1 and V2 typical of the syndrome previously described by the Brugadas (right bundle branch block, precordial ST elevations in V1-V3 and sudden cardiac death). A cardioverter-defibrillator was implanted. During the subsequent observation period of 2 month the ICD delivered one countershock, triggered by the onset of polymorphous ventricular tachycardia with syncope. CONCLUSION: In patients with serious ventricular arrhythmias but no diagnostic findings, including a normal resting ECG, a drug provocation test should be performed to exclude a Brugada syndrome.

Adult↗
PubMed2000

Prior cytomegalovirus, Chlamydia pneumoniae or Helicobacter pylori infection and the risk of restenosis after percutaneous transluminal coronary angioplasty.

We investigated a possible correlation between the serologic status concerning Cytomegalovirus (CMV), Chlamydia pneumoniae (CP) and Helicobacter pylori (HP) and the occurrence of restenosis in patients undergoing percutaneous transluminal coronary angioplasty for symptomatic coronary artery disease. Tests for anti-CMV IgG, anti-Chlamydia pneumoniae IgG and IgA and HP IgG and IgA were performed with an enzyme-linked immunosorbent assay (ELISA). Restenosis was defined as >/=50% stenosis at follow-up angiography in a vessel with less than 50% stenosis immediately after PTCA. Of 148 patients, 112 (75.7%) were seropositive for CMV, 75 (50.7%) were seropositive for CP and 78 (52.7%) were seropositive for HP. Restenosis occured in 31.8% of patients. CMV seropositivity was established in 74.5% of patients with restenosis versus 76.2% without restenosis (P=0.82), CP seropositivity was established in 44. 7% of patients with restenosis versus 53.5% without restenosis (P=0. 32), HP seropositivity was established in 53.2% of patients with restenosis versus 52.5% without restenosis (P=0.94). In contrast to some earlier studies CMV or HP seropositivity could not be found to be associated with the risk of restenosis after coronary intervention. An association between the serological status of CP and restenosis could also not be established.

Angioplasty, Balloon, Coronary↗
PubMed2000

Radiation doses to the cell nucleus in single cells and cells in micrometastases in targeted therapy with (131)I labeled ligands or antibodies.

PURPOSE: The aim of this study was to theoretically investigate how the radiation dose to cell nuclei depends on the subcellular position of (131)I. The influence of the size of the cells and crossfire irradiation in clusters of cells was also studied. METHODS AND MATERIAL: Using data describing the dose rate around a point source of (131)I, we calculated the dose distributions inside and around cell models of different sizes. The assumed positions of (131)I were on the cellular or nuclear membrane, in the cytoplasm, in the nucleus, or spread in the whole cell. The mean doses to the nucleus of the targeted cell and to the nuclei of its neighbors were calculated using the dose distributions. RESULTS: The dose distributions inside a single targeted cell showed very different distribution profiles depending on the subcellular position of the (131)I. Targeting the nucleus instead of the cellular membrane could increase the dose to the nucleus 10-fold. Crossfire irradiation can be the major contributor to the nuclear dose in clusters of more than six cells. CONCLUSIONS: Dosimetry without microscopic considerations is inadequate for targeted radionuclide therapy of disseminated or clustering tumor cells exposed to (131)I. Therapeutic doses could be achieved, even in single cells, when (131)I was positioned near, or inside the cell nucleus, or when the clusters were large enough.

Cell Count↗
PubMed2000

[Radioimmunotherapy is rapidly developing to clinically efficient therapy].

The use of monoclonal antibodies (mabs) in cancer therapy has gained renewed interest, due to recent reports of remarkable clinical response, particularly in patients with low-grade non-Hodgkin lymphoma. Better defined and more appropriate target antigens and "humanized" mabs, reducing the risk of inducing neutralising human anti-mouse antibodies, have contributed to the improvement in results. Conjugation of mabs with various radionuclides is now being explored as a means of further enhancing clinical efficacy, the idea being to allow systemic delivery of targeted radiation to areas of disease while sparing normal tissue. Radioimmunotherapy may be administered as a single large dose of radiolabelled mabs, usually requiring haematological stem cell support, or as multiple, smaller fractions. The criteria for the selection of mabs and radionuclides are discussed in the article, as are recent clinical data and the problems and prospects of future developments in radioimmunotherapy.

Clinical Trials as Topic↗
PubMed2000

[Ticlopidine-associated thrombotic thrombocytopenic purpura (Morbus Moschcowitz)].

ANAMNESIS AND CLINICAL FINDINGS: A 75-year-old woman with a history of recurrent ischemic cerebral events was admitted with acute unspecific neurological symptoms and fever. EXAMINATION: Intracerebral hemorrhage due to hypertension and antithrombotic therapy with ticlopidine was ruled out with cranial computed tomography. Laboratory findings on admission included thrombocytopenia (12/nl), renal insufficiency (serum creatinine 1.6 mg/dl) and LDH elevation (1,218 U/l). The hemoglobin on admission was normal. THERAPY AND CLINICAL COURSE: In the presence of rapidly declining hemoglobin values and fragmentation of red cells thrombotic-thrombocytopenic purpura (TTP) was diagnosed and the patient received fresh frozen plasma. Shortly after the plasma infusion the patient's condition deteriorated rapidly showing clinical signs of an allergic shock. In the sequel of 24 to 48 hours the patient developed renal failure, severe anemia and the thrombocyte count fell to 5/nl. The patient was mechanically ventilated during the next 48 hours and needed intravenous catecholamines. Even after restoration of spontaneous respiration and cessation of pharmacological sedation the patient remained comatose. Cranial computed tomography on the fourth day after admission showed multiple infarction syndrome. The patient died on the ninth day after admission in status epilepticus which could not be stopped with pharmacological means. CONCLUSIONS: The combination of neurological symptoms, thrombocytopenia, fever, renal failure and hemolytic anemia in a patient taking ticlopidine points to a diagnosis of TTP. The high mortality of TTP can probably only be reduced by early plasmapheresis.

Aged↗
PubMed2000

[Socioeconomic aspects of the treatment of arrhythmias].

In the current clinical cardiac electrophysiology well-defined and effective concepts regarding the diagnostic and treatment of cardiac arrhythmias have been introduced. A further improvement in the cost-benefit and the cost-effectiveness relationships in several fields of cardiac electrophysiology depends on the future technical progress and on the results of ongoing and future scientific studies. On the other side very cost-saving electrophysiological treatments had been developed; the broader clinical use of these treatments is a possibility to optimize the costs for patients' care with cardiac arrhythmias.

Adult↗
PubMed2000

[Acute myocardial infarction in patients with angiographically normal coronary arteries: clinical features and medium term follow-up].

BACKGROUND: Acute myocardial infarction (MI) in patients with normal coronary arteries has been recognized for several years. In most cases its etiology is unknown. The objective of the present study was to describe clinical features and medium term follow-up of those patients. PATIENTS AND METHODS: Between April 1991 and December 1996, 9860 coronary angiographies were performed in our hospital. During this period 17 patients with documented myocardial infarction and completely normal coronary arteries were identified. Acute myocardial infarction was defined as the clinical event with acute angina pectoris, ST-elevation typical for myocardial infarction, and an increase in serum creatinine phosphokinase (CPK) above 125 U/l. RESULTS: The mean peak CPK was 675 U/l (range: 129-1760 U/l). All 17 patients revealed significant ST-segment elevation. According to the ECG criteria there was no predilection for a specific location of MI (9 anterior MIs and 8 inferior MIs). Thrombolytic therapy was performed in 9 patients. In 12 patients areas of localized hypo- or akinesia were shown on left ventricular cineangiography. The mean ejection fraction was 61.5+/-10.3%. The age and sex distribution revealed a bimodel character: there was a younger age group of 9 patients, all men with a mean age of 35.9 years (31-43) and all strong cigarette smokers (mean 28 cigarettes/day) and there was an older group of 7 patients (1 man, 6 women) with a mean age of 56,4 years (47-68) and no significant association with cigarette smoking. During a mean follow-up period of 48.6 months (31-85 months) no patient died and no patient suffered from recurrent chest pain and used nitroglycerin occasionally. CONCLUSION: Patients with acute MI and angiographically normal coronary arteries show a bimodal sex and age distribution: a younger age group, all men and uniformly strong cigarette smokers and an older group predominantly women with no significant association with cigarette smoking. Both groups seem to have a favorable prognosis.

Adult↗
PubMed2000

[Neurological events in patients with atrial fibrillation: outcome and preventive practices].

BACKGROUND: Atrial fibrillation (AF) is associated with neurologic events (transient ischemic attack (TIA) and stroke). The objective of the present study was to determine the outcome of patients with neurological events and atrial fibrillation (AF) in comparison with patients in sinus rhythm (SR), and to investigate the primary and secondary prevention practices in patients with neurological events and AF. PATIENTS AND METHODS: In a prospective, observational, single center study in a large public, university-affiliated hospital all patients admitted between 1/97 and 1/98 with acute neurologic events were registered (n = 369). The association between outcome of neurologic events as assessed by survival status, functional status (Rankin scale) and severity of event (European Stroke Scale) and heart rhythm was investigated by use of logistic regression. Antithrombotic medication on admission and at discharge was recorded. RESULTS: The mean age of the 369 patients was 75.1 +/- 10.9 years; 56.1% were female. A TIA was present in 26.2% and stroke in 73.8%. 287 patients (77.8%) were in SR and 82 in AF on admission (22.2%). In-hospital mortality was 12.7% in all patients. In patients with AF, mortality was 23.2% and 9.8% in patients with SR (p = 0.0013). Patients with AF were significantly older than patients with SR (80.4 +/- 7.5 versus 73.5 +/- 11.2 years; p < 0.001). Multivariate analysis identified heart rhythm as an independent predictor of survival (p < 0.01). Patients with AF did suffer from a more severe neurological deficit on admission and at discharge than patients with SR. In 46.3% of patients with AF severe dependency was present (Rankin 4/5), while this was the case in 28.5% of patients with SR (p < 0.01). The ESS score of patients with AF was 77.4 +/- 30.6 at discharge compared to 88.1 +/- 20.3 in patients with SR (p < 0.01). In 50 of 82 patients (61%) AF was previously known. Of these 50 patients 36% did not receive any kind of antithrombotic treatment and only 12% were receiving oral anticoagulants before the event. Of 63 surviving patients with AF 32 did not have any contraindications against anticoagulation treatment. At discharge, 14 (43.8%) of these patients were receiving oral anticoagulants, 17 aspirin or ticlopidine (53.1%) and 1 patient (3.1%) no type of antithrombotic medication. CONCLUSIONS: Neurologic events in patients with AF are more severe and outcome is significantly poorer than in patients with SR. Anticoagulation as the effective therapy for primary and secondary prevention of neurologic events is seriously underused in daily practice.

Aged↗
PubMed2000

Percutaneous transluminal coronary angioplasty of left main stenosis--results of the German PTCA registry.

In cases with protected left main stenosis by previous bypass surgery or as an emergency intervention in patients presenting with acute myocardial infarction and cardiogenic shock, percutaneous transluminal coronary angioplasty is performed as an alternative treatment strategy to bypass surgery. A review of 262 left main angioplasties revealed a procedure-related mortality in cases without protection of the left main coronary artery of 9.1% (4/44), in cases with partially protected left main stenosis by collaterals to either left coronary artery of 4.8% (1/21) and 0.5% (1/187) in cases with nonobstructed bypass grafts to either left coronary artery. Coronary angioplasty of an unprotected left main coronary artery, had an unacceptably high procedure-related mortality rate and should therefore not be performed even in cases of emergency intervention. The risk stratification of the procedure can be evaluated by the proposed grading of left main artery protection.

Aged↗
PubMed2000

Desire for information about drugs. A multi-method study in general medical inpatients.

The purpose of this paper is to investigate patients' drug information preferences using a combination of quantitative and qualitative methods. Patient interviews (n = 299) were conducted on general medical wards in three London teaching hospitals. The purpose was to refine and validate a quantitative 12-item scale, the Intrinsic Desire for Information (IDI), by interfacing quantitative and qualitative data, and to explore the relationship between this scale score and patient demographics. The IDI-scale was subjected to factor analysis. Two secondary factors were found in the IDI scale; a 5-item factor describing the extent of information desired and a weaker 3-item factor describing an inhibited desire for knowledge about illness/drugs. Reliability analysis and multiple regression analysis were undertaken. Responses to open answer questions during the qualitative interviews were transcribed at the bedside and imported into QSR NUD*IST software program for coding and analysis. The methodology employed in this study involved importing quantitative, summative data into a qualitative data base and re-analysing both the quantitative and qualitative data to validate the scale. Age was a predominant factor associated with patient desire for information, although the data suggest that educational and socio-economic status are also influential. Factor 1, the extent of information desired, may have value in targeting receptive patients, or in identifying those who may be refractory to drug information. The refined tool could help health services to effectively target information provision based on evidence, rather than supposition.

Adult↗
PubMed2000

Differences in the growth inhibition of cultured K-562 cells by selenium, mercury or cadmium in two tissue culture media (RPMI-1640, Ham's F-10).

Effects of some metals on the growth of cultured human erythroleukemia K-562 cells were investigated when grown in two different types of media based upon RPMI-1640 or Ham's F-10. The study on proliferation, using RPMI-1640 supplemented with sodium selenite, selenomethionine, mercuric chloride, methylmercuric chloride and cadmium nitrate showed no inhibition of growth at concentrations of 2.5, 25, 25, 2.5 and 25 microM, while at 75, 250, 50, 5 and 50 microM toxicity was apparent. Selenite at 5-50 microM and selenomethionine at 50-100 microM inhibited the growth. In Ham's F-10 supplemented with the same compounds no inhibition was found at concentrations of 5, 10, 25, 1 and 50 microM, while at 50, 100, 50, 5 and 75 microM toxic effects were noted. Selenite 10 microM and selenomethionine 25-50 microM inhibited the proliferation. Measurements of trace element levels in pellets of K-562 cells grown in RPMI-1640 or Ham's F-10 unveiled higher cell contents of cadmium and selenium in cells grown in RPMI-1640, being consistent with higher concentrations of these elements in that medium. Manganese and mercury concentrations were higher in cells grown in Ham's F-10 correlating with a higher medium concentration of these elements. The growth responses and cellular uptake differed between the metals and the selenocompounds and although extrapolating the results to humans is difficult the selenium exposures were in approximately the same order of magnitude as in human exposures. The compounds could be ranked according to decreasing toxicity as: methylmercuric chloride > mercuric chloride, cadmium nitrate, sodium selenite > selenomethionine.

Cadmium↗
PubMed2000

Uptake and retention of selenite and selenomethionine in cultured K-562 cells.

The selenium uptake and retention have been studied in K-562 cells exposed to selenite or selenomethionine. In the uptake experiments the cells were exposed to two doses of selenite (5 or 50 microM) or selenomethionine (10 or 50 microM). In the retention study the cells were treated for 2 h with the above mentioned doses of the selenocompounds before being observed at different times. The selenium uptake in cells exposed to selenite 5 microM began to saturate at 8 h, but increased again between 48 and 96 h. In cells exposed to selenite 50 microM the selenium uptake never reached a maximum, however, at 48 and 96 h the cell viability decreased strongly. The two doses of selenite showed different retention patterns, with a relatively small cellular decrease of selenium after treatment with selenite 5 microM compared to treatment with 50 microM of selenite. The selenium uptake in cells exposed to selenomethionine 10 microM or selenomethionine 50 microM began to saturate at 24 h and 48 h, respectively. The retention patterns were similar for both selenomethionine doses with a continuous decrease of the selenium concentration during the whole observation period. The results indicated a more controlled uptake and retention pattern of selenomethionine compared to selenite.

Humans↗
PubMed2000

Electrophysiological heterogeneity of atrial fibrillation and local effect of propafenone in the human right atrium: analysis based on symbolic dynamics.

UNLABELLED: A recently developed algorithm that is based on symbolic dynamics and computation of the normalized algorithmic complexity (C(alpha)) was applied to basket-catheter mapping of the atrial fibrillation (AF). The aim of our study was to analyze the spatial distribution of the C(alpha) during AF and effects of propafenone on this distribution. During right atrial mapping in 25 patients with AF 31 intra-atrial and 1 surface bipolar channels were acquired. The anatomical location of the intra-atrial electrodes was defined fluoroscopically. C(alpha) was calculated for a moving window (size: 2000 points; step 500 points). Generated C(alpha) was analyzed within 10 minutes before and after administration of propafenone. The inter-regional C(alpha) distribution was analyzed using the Friedman-test (intra-individually) and Kruskall-Wallis-H-test (inter- individually). A value of p=0.05 was set for an error probability. Inter-regional C(alpha) differences were found in all patients (p<0.001). The right atrium could be divided in high- and low complexity areas according to individual patterns. A significant C(alpha) increase in cranio-caudal direction (with the exception of septum) was confirmed inter-individually (p<0.01). The administration of propafenone enlarged the areas of low complexity. CONCLUSIONS: This new method utilizing the combination of symbolic dynamics and adaptive power estimation can provide complex evaluation of the dynamics of AF in man. High-density mapping will be required for further evaluation of results.

Algorithms↗